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Ben Rejeb M, Ben Cheikh A, Bhiri S, Ghali H, khefacha-Aissa S, Said-Latiri H. Implementation of Adverse event surveillance system in a Tunisian tertiary care hospital (2018-2019). Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
We found a high incidence of Adverse Events (AEs) following a survey conducted at Sahloul Hospital. Therefore, a surveillance system of AEs was implemented as a part of the implementation of the quality and risk management approach at Sahloul hospital, since April 2018. The aim of this study was to describe results of this system between May 2018 and April 2019.
Methods
It is a descriptive longitudinal study conducted at the Sahloul Hospital for a period of one year from May 1st, 2018 to April 30, 2019. Each service is provided with a data sheet that allows staff to report each adverse event they have witnessed. This does not include AEs that are part of alertness, blood exposure accidents or occupational accidents, or nosocomial infections which are assessed by specific circuits already in place.
Results
During the follow-up period, 93 AEs were reported. These AEs predominate in the sterilization unit followed by medical resuscitation and nephrology department with respective rates of 17.2%, 12.9% and 11.8%. The most frequent AEs were for maintenance (21.5%), medical device disinfection (20.5%), material resources (16.1%), and human resources (8.6%). According to criticality, the majority of AEs are tolerable under control (41.9%), unacceptable in 33.3% of cases and acceptable in 24.7% of cases.
Conclusions
In order to ensure proper functioning of the AEs surveillance and reporting system, the awareness of health professionals and their training would be essential. Quality of the information to be reported represents a challenge to be met to enable the planning, implementation and evaluation of improvement actions. Experience feedback would be with considerable benefit to improve the quality of professional practices.
Key messages
Surveillance and reporting system data analysis allow to identify mecanisms of the occurence of adverse events. Experience feedback is with considerable benefit to improve the quality of professional practices.
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Affiliation(s)
- M Ben Rejeb
- Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
- Department of Prevention and Care Safety, Sahloul University Hospital, Sousse, Tunisia
| | - A Ben Cheikh
- Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
- Department of Prevention and Care Safety, Sahloul University Hospital, Sousse, Tunisia
| | - S Bhiri
- Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
- Department of Prevention and Care Safety, Sahloul University Hospital, Sousse, Tunisia
| | - H Ghali
- Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
- Department of Prevention and Care Safety, Sahloul University Hospital, Sousse, Tunisia
| | - S khefacha-Aissa
- Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
- Department of Prevention and Care Safety, Sahloul University Hospital, Sousse, Tunisia
| | - H Said-Latiri
- Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
- Department of Prevention and Care Safety, Sahloul University Hospital, Sousse, Tunisia
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Ben Rejeb M, Ben Cheikh A, Bhiri S, Ghali H, Kahloul M, Khefacha-Aissa S, Hmouda H, Bouallegue O, Said-Latiri H. Results of screening for emergent highly resistant bacteria in Tunisian intensive care units. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
The infections caused by emergent highly resistant bacteria (eHBR) that develop in intensive care units (ICUs) may result in significant patient illnesses and deaths, extend the duration of hospital stays and generate added costs. Facing this problem, the screening that emphasizes early identification of colonized patients, reduces the prevalence and incidence of infection, improves patient outcomes and reduces healthcare costs. In this context, we have implemented a screening for eHBR in ICUs of Sahloul university hospital of Sousse (Tunisia), which we report in this study the first six-months outcomes.
Methods
Rectal swab cultures were collected to detect Vancomycin resistant enterococcus (VRE) and Carbapenemase producing Enterobacteriaceae (CPE) among patients admitted in six ICUs of Sahloul university hospital of Sousse (Tunisia) and more than three times, at least one week apart, between 1 June and 31 December 2018.
Results
During the study period 174 patients were screened. Of them, 69.5% were male and 73.6% were admitted in surgical ICU. In total, 161 and 152 samples were realized respectively for the detection of CPE and VRE. These samples were positive in 15% and 8.5% respectively for CPE and VRE. Klebsiella pneumoniae OXA 48 was the most isolated CPE (80%).
Conclusions
Our screening program helped us in infection control by early identification of patients, thereby facilitating an informed decision about infection prevention interventions. Moreover, these results encouraged us to improve and generalize this program throughout the hospital.
Key messages
eHRB screening becomes an important axis in the prevention of eHRB infections in our facilities. eHRB screening allows the reinforcement of the basic infection prevention and control measures.
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Affiliation(s)
- M Ben Rejeb
- Faculty of Medicine of Sousse, University of Sousse, Faculty of Medicine, Sousse, Tunisia
- Department of Prevention and Care Safety, Sahloul University Hospital, Sousse, Tunisia
| | - A Ben Cheikh
- Faculty of Medicine of Sousse, University of Sousse, Faculty of Medicine, Sousse, Tunisia
- Department of Prevention and Care Safety, Sahloul University Hospital, Sousse, Tunisia
| | - S Bhiri
- Faculty of Medicine of Sousse, University of Sousse, Faculty of Medicine, Sousse, Tunisia
- Department of Prevention and Care Safety, Sahloul University Hospital, Sousse, Tunisia
| | - H Ghali
- Faculty of Medicine of Sousse, University of Sousse, Faculty of Medicine, Sousse, Tunisia
- Department of Prevention and Care Safety, Sahloul University Hospital, Sousse, Tunisia
| | - M Kahloul
- Faculty of Medicine of Sousse, University of Sousse, Faculty of Medicine, Sousse, Tunisia
- Surgical Intensive care Unit, Sahloul University Hospital, Sousse, Tunisia
| | - S Khefacha-Aissa
- Faculty of Medicine of Sousse, University of Sousse, Faculty of Medicine, Sousse, Tunisia
- Department of Prevention and Care Safety, Sahloul University Hospital, Sousse, Tunisia
| | - H Hmouda
- Faculty of Medicine of Sousse, University of Sousse, Faculty of Medicine, Sousse, Tunisia
- Medical Intensive care Unit, Sahloul University Hospital, Sousse, Tunisia
| | - O Bouallegue
- Faculty of Medicine of Sousse, University of Sousse, Faculty of Medicine, Sousse, Tunisia
- Laboratory of Microbiology, Sahloul University Hospital, Sousse, Tunisia
| | - H Said-Latiri
- Faculty of Medicine of Sousse, University of Sousse, Faculty of Medicine, Sousse, Tunisia
- Department of Prevention and Care Safety, Sahloul University Hospital, Sousse, Tunisia
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Ben Rejeb M, Said-Latiri H, Zedini CH, Nabli-Ajmi TH, Dhidah L, Mtiraoui A. Capacity building process – medical curricula implications on the long term. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Currently, the Tunisian medical schools are going through a transition period marked by the reform of medical studies. Their curricula must be adapted to globally recognized medical education guidelines. Aware of the importance of teaching scientific research and public health, they are making efforts to integrate this new approach of education within several levels (undergraduate, postgraduate and continuous professional development). In this perspective, the public health research centres (C4EHPs) created under the CONFIDE project provide an opportunity to support such integration.
The progress
The Faculty of Medicine of Sousse was founded in the 70s to open up to its local and regional community. So, the public health topic was one of the top priorities. With the reform started in 2011, the importance of this topic has been further developed by integrating many modules that cover different aspects of public health throughout the curriculum. In this context, the materials, modules and information developed within the CONFIDE project complement the existing modules and bring a fresh perspective on the teaching methods. The faculty of Medicine of Sousse will integrate this information in the curricula to promote scientific production by allowing students to build up their scientific research knowledge, develop higher research competencies such as critical-thinking, problem-solving and data interpretation and analysis and train public health specialists to be health policy makers in the future.
Conclusions
Integrating the new approach based on the achievements of the C4EHP is an essential step for our faculty to develop more training in public health, ensure good quality of its teaching process and participate in the development of health policies that will improve the health of the Tunisian population.
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Affiliation(s)
- M Ben Rejeb
- Faculty of Medicine, University of Sousse, Sousse, Tunisia
| | - H Said-Latiri
- Faculty of Medicine, University of Sousse, Sousse, Tunisia
| | - C h Zedini
- Faculty of Medicine, University of Sousse, Sousse, Tunisia
| | - T h Nabli-Ajmi
- Faculty of Medicine, University of Sousse, Sousse, Tunisia
| | - L Dhidah
- Faculty of Medicine, University of Sousse, Sousse, Tunisia
| | - A Mtiraoui
- Faculty of Medicine, University of Sousse, Sousse, Tunisia
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Merzougui L, Ben Helel K, Hanachi H, Metjaouel H, Brini H, Barkallah M, Ben Rejeb M, Said-Latiri H. Facteurs de risque de l’infection nosocomiale Bactérienne au niveau d’un centre de néonatologie du Centre Tunisien. « Étude cas-témoin » : à propos de 184 cas. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.jpp.2017.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Ben Helel K, Ben Rejeb M, Habboul Z, Khattat N, Mejaouel H, Said-Latiri H, Kaabi B, Zhioua E. Risk factors for mortality of children with zoonotic visceral leishmaniasis in Central Tunisia. PLoS One 2017; 12:e0189725. [PMID: 29287082 PMCID: PMC5747430 DOI: 10.1371/journal.pone.0189725] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 11/30/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Zoonotic visceral leishmaniasis (ZVL) caused by Leishmania infantum is endemic with an epidemiological profile of a paediatric disease in Tunisia. In the context of a high fatality rate, identifying risk factors for in-hospital mortality in children treated for ZVL is of major epidemiological importance. DESIGN A retrospective (case-control) study included 230 immuno-competent children diagnosed and confirmed with primary ZVL in the paediatric department of the University Hospital of Kairouan between 2004 and 2014. Forty-seven per cent (47%) were children under 18 months of age, and with a male ⁄ female ratio of 1.01:1. RESULTS The overall case-fatality was 6% (n = 14). The risk factors for in-hospital death identified by a multivariate analysis were: bleeding at admission (OR = 25.5, 95% CI: 2.26-287.4; p = 0.009), white cell count less than 4000/mm3 (OR = 5.66, 95% CI: 1.16-27.6; p = 0.032), cytolysis (OR = 28.13, 95% CI: 4.55-173.6; p < 0.001), and delay between onset of symptoms and admission ≥ 15 days (OR = 11, 95% CI: 1.68-72; p = 0.012). CONCLUSION The results strongly suggest that paediatric patients admitted 15 days after onset of symptoms, with bleeding, white cell counts below 4,000/mm3, and cytolysis at admission should be considered severe cases and subsequently, they are at high risk of mortality. A better understanding of factors associated with death of children from ZVL may contribute to decrease mortality.
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Affiliation(s)
- Khaled Ben Helel
- Pediatric Department of University Hospital of Kairouan, Kairouan, Tunisia
| | - Mohamed Ben Rejeb
- Department of Prevention and Care Safety, University Hospital of Sahloul, Sousse, Tunisia
| | - Zakia Habboul
- Pediatric Department of University Hospital of Kairouan, Kairouan, Tunisia
| | - Nizar Khattat
- Pediatric Department of University Hospital of Kairouan, Kairouan, Tunisia
| | - Houssain Mejaouel
- Pediatric Department of University Hospital of Kairouan, Kairouan, Tunisia
| | - Houyem Said-Latiri
- Department of Prevention and Care Safety, University Hospital of Sahloul, Sousse, Tunisia
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Rejeb MB, Sahli J, Chebil D, Khefacha-Aissa S, Jaidane N, Kacem B, Hmouda H, Dhidah L, Said-Latiri H, Naija W. Mortality among Patients with Nosocomial Infections in Tertiary Intensive Care Units of Sahloul Hospital, Sousse, Tunisia. Arch Iran Med 2016; 19:179-85. [PMID: 26923889 DOI: 0161903/aim.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Nosocomial infections are public health issues that are associated with high mortality in intensive care units. This study aimed to determine nosocomial infection-associated mortality in Tunisian intensive care units and identify its risk factors. METHODS A prospective cohort study was carried out in intensive care units of a Tunisian University Hospital. The ICUs-wide active surveillance of nosocomial infections has been performed between 1 July 2010 and 30 June 2011. Data collection was based on Rea-Raisin protocol 2009 of "Institut National de Veille Sanitaire" (InVS, Saint Maurice - France). We used Kaplan Meier survival analysis and Cox Proportional Hazard regression to identify independent risk factors of nosocomial infection-associated mortality. RESULTS Sixty-seven patients presented nosocomial infection in the end of the surveillance. The mean age of patients was 44.71 ± 21.2 years. Of them, 67.2% were male and 32.8% female. Nosocomial bacteremia was the most frequent infection (68.6%). Nosocomial infection-associated mortality rate was 35.8% (24/67). Bacteremia (Hazard Ratio (HR)) = 3.03, 95% Confidential Interval (95% CI): [1.23 - 7.45], P = 0.016) and trauma (HR = 3.6, 95% CI: [1.16 - 11.2], P = 0.026) were identified by Cox regression as independent risk factors for NI-associated mortality. CONCLUSIONS Our rate was relatively high. We need to improve the care of trauma patients and intensify the fight against nosocomial infections especially bacteremia.
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Affiliation(s)
- Mohamed Ben Rejeb
- Department of Prevention and Care Safety, Hospital of Sahloul, Route Ceinture Sahloul, Sousse, Tunisia. ,
| | - Jihene Sahli
- Department of Prevention and Care Safety, Hospital of Sahloul, Route Ceinture Sahloul, Sousse, Tunisia
| | - Dhekra Chebil
- Department of Prevention and Care Safety, Hospital of Sahloul, Route Ceinture Sahloul, Sousse, Tunisia
| | - Selwa Khefacha-Aissa
- Department of Prevention and Care Safety, Hospital of Sahloul, Route Ceinture Sahloul, Sousse, Tunisia
| | - Nadia Jaidane
- Department of Prevention and Care Safety, Hospital of Sahloul, Route Ceinture Sahloul, Sousse, Tunisia
| | - Balsam Kacem
- Department of Prevention and Care Safety, Hospital of Sahloul, Route Ceinture Sahloul, Sousse, Tunisia
| | - Houssem Hmouda
- Department of Medical Intensive Care, Hospital of Sahloul, Route Ceinture Sahloul, Sousse, Tunisia
| | - Lamine Dhidah
- Department of Prevention and Care Safety, Hospital of Sahloul, Route Ceinture Sahloul, Sousse, Tunisia
| | - Houyem Said-Latiri
- Department of Prevention and Care Safety, Hospital of Sahloul, Route Ceinture Sahloul, Sousse, Tunisia
| | - Walid Naija
- Department of Surgical Intensive Care, Hospital of Sahloul, Route Ceinture Sahloul, Sousse, Tunisia
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Ben Rejeb M, Abroug H, Khefacha-Aissa S, Ben Fredj M, Dhidah L, Said-Latiri H. [Smoking behavior, knowledge, and attitudes towards anti-smoking regulations of nursing students in Sousse, Tunisia]. Rev Epidemiol Sante Publique 2016; 64:121-7. [PMID: 26915428 DOI: 10.1016/j.respe.2015.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 11/18/2015] [Accepted: 12/01/2015] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Smoking prevalence has reached high rates among health professionals. Our study aimed to assess smoking behavior, knowledge and attitudes towards anti-smoking regulations of nursing students. METHODS In 2013, we conducted a cross-sectional study among nursing students enrolled in private and state nursing institutions of Sousse (Tunisia). RESULTS In our study, 440 students were selected. The mean age was 22 ± 2 years. The sex ratio was 0.65. The prevalence of smoking was 20.6%. It was significantly higher in men than women (50% vs 4.5%, P < 10(-3)). Strong dependency was noted in 9%. One-third of smokers stated they wanted to quit smoking. Prohibiting the sale of cigarettes to minors and smoking in enclosed public places were the two most mentioned anti-smoking regulations. CONCLUSION Our rate was lower than those reported in the literature. This result should encourage policymakers to continue actions and ensure sustainability.
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Affiliation(s)
- M Ben Rejeb
- Service de prévention et de sécurité des soins, hôpital Sahloul, Sousse, Tunisie.
| | - H Abroug
- Service de prévention et de sécurité des soins, hôpital Sahloul, Sousse, Tunisie
| | - S Khefacha-Aissa
- Service de prévention et de sécurité des soins, hôpital Sahloul, Sousse, Tunisie
| | - M Ben Fredj
- Service de prévention et de sécurité des soins, hôpital Sahloul, Sousse, Tunisie
| | - L Dhidah
- Service de prévention et de sécurité des soins, hôpital Sahloul, Sousse, Tunisie
| | - H Said-Latiri
- Service de prévention et de sécurité des soins, hôpital Sahloul, Sousse, Tunisie
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Ben Rejeb M, Marzougui L, Ben Fradj M, Bouallègue O, Said-Latiri H. Résistance bactérienne et prescription antibiotique : perceptions, attitudes et connaissances d’un échantillon de médecins hospitaliers. Étude au CHU Sahloul – Sousse – Tunisie. Rev Epidemiol Sante Publique 2014. [DOI: 10.1016/j.respe.2014.06.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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